We are pleased to present the eleventh annual New Jersey HMO Performance Report, the second produced exclusively by the New Jersey Department of Banking and Insurance.This report contains information on the performance of New Jersey’s health maintenance organizations (HMOs), how well these HMOs deliver important health care services, and how members rate the services they receive.

The report is designed to give consumers and employers information on the quality of New Jersey’s HMOs and the coverage they provide. We believe that you will find this information useful when choosing health coverage for your family or business.

New Jersey is a leader in providing comprehensive, strong consumer and patient protections. We urge you to become familiar with these protections, which are explained in this report.

By providing you with this report, we strive to empower you to make the best health care choices for you, your family or your employees.

Jon S. Corzine
Governor

Steven M. Goldman
Commissioner
Department of Banking and Insurance

The format for this report was originally developed by the New Jersey Department of Health and Senior Services (DHSS), when it issued the first HMO performance report in 1997 with the cooperation of an advisory group representing HMOs, health care purchasers, providers and consumers. The New Jersey Department of Banking and Insurance (DOBI) assumed responsibility for providing the HMO Performance Report from DHSS in August 2005, pursuant to Reorganization Plan 05-005. All regulatory and oversight matters concerning managed health care in the state are now consolidated in DOBI.

This report includes information on all commercial products currently marketed in New Jersey by HMOs that had at least 2,000 members enrolled in commercial products in both 2005 and 2006. For most HMOs the information combines plan performance for the HMO and POS products.Click herefor more information about thedistinction between HMO and POS products.

This report does not include HMO performance related to any HMO’s Medicare or Medicaid business or an HMO’s business related to other New Jersey Department of Human Services programs. Click herefor ways you can obtain information onthese plans.

This report is based on a measurement system called HEDIS®, which was developed by the National Committee for Quality Assurance (NCQA) through the combined efforts of many health care experts. It includes measures collected by the HMOs and measures collected through member surveys. All measures are verified by independent auditors.

This report contains information on the following HMOs and products:

Aetna-HMO/POS (Aetna Health, Inc.–New Jersey)

AmeriHealth-HMO/POS (AmeriHealth HMO)

CIGNA-HMO/POS (CIGNA HealthCare of New Jersey)

Health Net-HMO/POS (Health Net of New Jersey, Inc.)

Horizon-HMO (Horizon Healthcare of New Jersey)

Oxford-HMO/POS (Oxford Health Plans–New Jersey)

Click herefor information on contacting these and otherNew Jersey HMOs

HEDIS® is a registered trademark of the National Committee for Quality Assurance.

Data analysis was provided by the Center for State Health Policy, Rutgers, the State University of New Jersey.

OPRA is
a state law that was enacted to give the public greater access to government
records maintained by public agencies in New Jersey.

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